Coding and Documentation for Hypoglossal Nerve Stimulation Procedures

Hypoglossal Nerve Stimulant placement is mainly used to treat obstructive sleep apnea. 

This is a surgically implanted device that stimulates the nerves that move the tongue and open the airway while a person sleeps. This device is recommended when a CPAP device is not tolerable.  As of 2023, the only hypoglossal nerve stimulator that is approved by the Food and Drug Administration is the Inspire device. 

Components of a Hypoglossal Nerve Stimulation System

Breathing monitor, Pulse generator, Electrode(s), Hand-held remote control 

Inspire Device Models and System Differences

*Inspire IV: three implantable components – the Inspire device, a stimulation lead and a respiratory sensing lead 

*Inspire V: (newer version) eliminates the separate respiratory sensing lead, resulting in a simpler two-component system. 

Covered by most insurances, however commercial insurances may only cover the procedure for people with BMI of 32 or less.   

Coverage and Diagnosis Requirements

• G47.33 Obstructive Sleep Apnea (adult)(pediatric) 
• BMI code (Z68.1-Z68.34) 

CPT Coding for Hypoglossal Nerve Stimulator Procedures

• 64582 – Implant Inspire IV or 64568 – Implant Inspire V 
• 64583 – Revision/Replacement of breathing & nerve stimulator electrodes 
• 64584 – Removal of device (electrodes & generator) 
• 61885 - Revisions from Inspire IV to Inspire V 
• 61886 - Generator replacement with connection to 2 or more electrodes 

* Append modifier 52 in instances where only a portion of the device listed in the description is revised/removed (e.g., revision of breathing sensor lead only or revision of stimulation lead only) 

Practical Application

• Confirm payer coverage, especially BMI limits for commercial plans. 
• Review the operative note to determine if the full device or only a component was revised (use modifier 52 if partial). 
• Select the correct CPT based on Inspire model (IV vs. V). 
• For Medicare, always include both OSA and BMI codes.